ATLANTA, Ga – Eight years ago, the Center for Disease Dynamics, Economics & Policy broadened its U.S.-based work on antimicrobial resistance to reach out to a small number of low-income countries.
The goal, presenters here said Wednesday, was to support creation of in-country groups that could build national responses to antimicrobial resistance. The hope, Hellen Gelband, CDDEP Associate Director for Policy, said was “to strengthen the low and middle- income country voice in the global conversation” about bacteria, viruses, parasites and fungi resistant to treatments.
With funding from the Bill & Melinda Gates Foundation, CDDEP offered resources, technical assistance and funding to pay a coordinator for country-based Global Antibiotic Resistance Partnerships — GARPs — in Kenya, India, South Africa and Vietnam, that would work to create national capacity to follow the evolution of antimicrobial resistance, to provide advice to government and the private sector, and support education efforts for the public and health care professionals.
CDDEP expanded its reach to Mozambique, Nepal, Tanzania and Uganda in 2012, and are working in Zambia, Zimbabwe, Bangladesh, Pakistan and Laos with the current active groups serving as mentors to the new groups, guiding them to establish affiliations with medical and research organizations and encourage government participation while remaining independent of government.
The initial focus of the group in Kenya, where half of all deaths are related to infectious diseases, Dr. Tom Menge, the chief pharmacist from Kenyatta National Hospital in Nairobi and a leader of the Kenya GARP said, was research that included a study of knowledge, attitudes and practice regarding antibiotic use in public, private and mission hospitals in two provinces, as well as an assessment of antibiotic use in livestock and antibiotic resistant pathogens in slaughterhouses and meat sold to consumers. Findings, he said, showed rising trends of antibiotic resistance and widespread inappropriate antibiotic use in humans and animals. Actions from the GARP included the creation of a short course on antimicrobial resistance for health care professionals in training and practicing clinicians. The group also has advocated for the establishment of a national antimicrobial resistance program as well as a national antimicrobial stewardship advisory committee, and for the appointment of antimicrobial resistance leaders in the government health and agriculture ministries.
“We need more data,” Menges said, adding that information on the volume of antibiotics used at the community level and on prescription practices is limited. Issues include over-the-counter sales of antibiotics, he said. Menges pointed to the control of antiretrovirals and the newer tuberculosis drugs as models for the future control of antimicrobial medications.
In Mozambique, where infectious diseases are the leading causes of death, where adult life expectancy averages 50 years for men and 52 for women, and where rates of maternal and child mortality are high, challenges include about a quarter of children under five without access to preventive vaccines, overall limited access to formal health care, and the widespread sale of antibiotics for profit outside the health system, Dr Esperança Sevene from Eduardo Mondlane University in Maputo said. In addition, the Mozambique group’s analysis found that regulations for antibiotic use in animals were extremely limited. The Mozambique national action plan now under review focuses on six areas including improving hospital infection control and laboratory capacity for diagnosis and surveillance, educating health professionals and policymakers, reducing antibiotic use in animals, and prioritizing diseases affecting children under 5 years old by ramping up immunizations and monitoring antibiotic use.